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III. CLASSIFICATION
Levels of asthma control. Asthma is now classified according to
intensity of treatment needed to control symptoms. Refer to the
Appendix for levels of asthma control.
IV. TREATMENT
Controllers- daily, long-term basis to keep asthma control;
mainly anti-inflammatory. Includes inhaled/ systemic
glucocorticosteroids, leukotriene modifiers, long-acting Beta 2
agonists with inhaled glucocorticosteroids, sustained-release
theophyllines, cromones, anti-IgE
o Inhaled corticosteroids- most effective anti-inflammatory for long-
term asthma, also recommended for children of all ages with
asthma; side effects include oropharyngeal candidiasis,
dysphonia, adrenal suppression, easy bruisability, decreased
bone mineral density.
o Leukotriene modifiers- mild bronchodilator effect; used as add-
on treatment to decrease dose of glucocorticoids
o Long-acting inhaled bronchodilators- Long-acting beta 2 agonists
like formoterol and salmeterol not used as monotherapy; usually
combined with glucocorticosteroids; fewer systemic effects than
oral therapy
o Theophyllines- modest anti-inflammatory effect; side effects
arrhymias, seizures, nausea and vomiting (most common)
o Cromones- limited effects
o Systemic glucocorticosteroids- for severely uncontrolled asthma;
side effects include diabetes,arterial hypertension, HPA
suppression, osteoporosis, cataractacts
Relievers- as-needed basis for bronchoconstriction. Includes
rapid-acting inhaled Beta 2 agonists, short-acting oral Beta agonists,
anticholinergics, short-acting theophyllines
o Rapid-acting inhaled Beta 2 agonists- Only on as-need basis at
lowest dose and frequency most effective bronchodilators,
preferred treatment in children; side effects include skeletal
muscle tremors, headaches, palpitations, agitation
o Anticholinergics- ipratropium/oxitropium bromide, less effective
than rapid acting Beta 2 agonists
Family Medicine: Asthma (GINA Guidelines 2012) FCH 250
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APPENDIX